GRASSP Version 2: A comprehensive SCI upper limb outcome measure
1Kalsi-Ryan S, 2Albisser U, 3Fehlings M, 2Curt A, 4Verrier M, 5Fellinghauer C, 6Velstra I
1Toronto Rehabilitation Institute - UHN, Toronto, Ontario, Canada; 2University Hospital, Balgrist, Zurich, , Switzerland; 3Toronto Western Hospital - UHN, Toronto, , Canada; 4University of Toronto, Toronto, Ontario, Canada; 5Swiss Paraplegic Research, ICF Unit; University Lucerne, Department of Health Science and Health Policy, Lucerne, , Switzerland; 6Swiss Paraplegic Centre Nottwil, Clinical Trial Unit, Nottwil, , Switzerland
Introduction/Background: The GRASSP Version 1 (GV1) was made available to the SCI community in 2010. Uptake and interest in the measure has been significant. GV1 consists of 5 subtests GRASSP Strength (GR-Str), Sensation (GR-Sens), Prehension Ability (GR-pa) and Prehension Performance (GR-pp). GV1 has excellent psychometric properties, is sensitive to small changes in impairment and function, however, an abbreviated version to further enhance uptake was of interest to the developers and the field.
Objective: Refine and modify GV1 to render GRASSP Version 2 (GV2), ensuring retained sensitivity and minimal disruption to existing users of GV1.
Methods: GV1 was administered serially on an observational cohort (n=77) at approximately 10 days,1, 3, 6 and 12 months post cervical spinal cord injury (SCI). Rasch analysis was performed on the longitudinal dataset for each GRASSP subtest, to identify the most relevant items for a reduced assessment of the domains.Cumulative end-user feedback from Europe and Canada was collected and archived. Feedback was reviewed for common themes and changes were applied. The sum mean score of GR-Str (5 muscles of ISNCSCI) was compared to the sum mean of the upper extremity motor score (UEMS) using paired t-test. All data gathered were synthesized. Consequential modifications were derived and applied to GV1.
Results: Based on end-user feedback: 1) language throughout the manual was refined to clarify subtest/item definitions and instructions to reduce variability of interpretation among assessors. 2) Paired t-test confirmed no significant difference between sum mean scores of GR-Str and UEMS. Rasch analysis confirmed that some items in the GR-sens subtest to be redundant which permits selecting a smaller set of relevant items. Furthermore a reduction of tasks from 6 to 4 within the GR-pp subtest was based on clinical expertise and did not impact the reliability of the subscale.
1. GR-Str, Isotonic Manual Muscle Testing (MMT) to isometric MMT.
2. GR-Sens, Reduction of 6 test locations to 3 per hand.
3. GR-pp, Reduction of 6 items to 4 items.
4. Instruction manual revised for improved objectivity and standardization.
Conclusions: GV1 was modified to render GV2. This modifications made have improved objectivity of GRASSP, reduced assessment time, with minimal change to sensitivity of the tool. GV2 was launched in the Fall of 2017.
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